STOP Selling, Start HELPING: Why Motivational Interviewing is Essential
The one word that describes Dr. Brad Stewart is simple - passionate. Brad believes that better hearing is served through motivational interviewing techniques to ensure trust is built between the provider and the patient. Think back to the last time you went to the doctor and didn't "jive" with the provider. Did they lack empathy? Were they just having an "off" day? Were they rushing through the appointment? Chances are, you got home and said to yourself, "Well, I think I am going to get a second opinion."
In hearing healthcare, we really only have one shot to make sure that the new patients that come to our office for the first time have the BEST experience possible. Why? Because said patient waited 7-10 years to see you, the hearing healthcare provider. If they have a lackluster experience, they may just hang up their hearing cleats and say, "I'll try again in another 7 years." This is not what we want!
What is Motivational Interviewing?
The most current version of MI is described in detail in Miller and Rollnick (2013) Motivational Interviewing: Helping people to change (3rd edition). Key qualities include:
The In-Office Hearing Aid Demo
During this episode, Blaise and Brad discuss the importance of demoing hearing technology during the patient's office visit. The in-office hearing aid demo is an essential element of a patient's first visit. One of the reasons office's should implement the in-office demo is because patient's have been waiting YEARS to hear with increased clarity, you want your new patient to leave your office excited about their new hearing world! (Disclaimer: of course, the in-office demo depends on the patients type and degree of hearing loss.)
Brad has strong opinions about the in-office demo and states, "We have the ability during a 90 minute consultation to change that and to let them experience what hearing is like again. And for a lot of these people, it's been half a decade, a decade, 20 years since they've heard normally. And so that's like such an experience, such a light bulb moment. It's a peak experience. It's something they will remember throughout their life this time when they heard well again. And that we would just like for the sake of efficiency or time just wouldn't do that, and wouldn't allow them to experience such a transformative moment, seems crazy to me. And I have a really hard time rationalizing why you wouldn't do that."
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Blaise M. Delfino, M.S. - HIS (00:06):
You're tuned in to the Hearing Matters Podcast. The show that discusses hearing technology, best practices, and a growing national epidemic: Hearing Loss. Before we kick this episode off. a special thank you to our partners: Sycle - Built for the Entire Hearing Care Practice. Weave - the all-in-one patient communication and engagement platform. Redux - Faster. Drier. Smarter. Verified. Fader Plugs - the world's first custom adjustable earplug. Welcome back to the Hearing Matters Podcast. I'm your host, Blaise Delfino, and joining us again is Dr. Brad Stewart. If you tuned in last month, we talked all things mobile audiology, scaling, one of our favorite books, the EMyth, and how important systems and processes are. Well, we have a treat for you today. Dr. Brad is going to talk about case presentation, aka, the hearing aid sales presentation. Brad, welcome back to the Hearing Matters Podcast.
Dr. Brad Stewart (01:12):
Thanks so much for having me back.
Blaise M. Delfino, M.S. - HIS (01:14):
So, last episode, we had a ton of fun, really enjoyed talking to you, and today we're gonna talk about sales. Now, for some they hear that word and they cringe. What do you mean sales? You know, if we think about it, Brad, every one of us, we're selling every day. We're selling on our thoughts, our ideas, who we are as an individual, but what is really important and what is very intimate is the hearing aid sales process. And who better to talk about this than you, yourself, Brad, especially having to create a sales presentation in the mobile audiology vertical, and then vestibular, and then running a private practice. So, the floor is yours, my friend. Let's talk all things sales and motivational interviewing.
Dr. Brad Stewart (01:59):
Yeah, that sounds great. This is a really interesting topic and I know that that word is loaded, so I'm excited to <laugh> to get into it and talk a little bit more.
Blaise M. Delfino, M.S. - HIS (02:08):
Absolutely. So Brad, as I said a little earlier, the hearing aids sales process is very intimate. Years ago, there wasn't as much information out on the internet about hearing aids and hearing healthcare. So, now providers really need to be on their A game when they are talking about the hearing aid, why the patient really needs them, and how it fits their needs, not only for hearing loss, but for communication in general. So, bring us through the foundation all the way up to building the roof of the sales model. How important is it to start with motivational interviewing when you're first working with a patient?
Dr. Brad Stewart (02:50):
I think that it's important to define what motivational interviewing is. Motivational interviewing is this kind of counseling framework that was really actually developed, it's, uh, designed to promote behavior change. So, for like addiction counselors and that sort of thing was really the types of fields that it was initially developed in. And when we talk about hearing treatment, one of the most common things that we experience as audiologists working with patients is ambivalence. The sense that like, I know I have a problem, but I don't really want to treat this problem with hearing aids. Right? And so, and, and families of people who have hearing loss deal with the same thing. You know, how many, how many patients have you had come in because their spouse was just so fed up with their inability to communicate? Oh. Uh, and it's been such a source of conflict at home.
Blaise M. Delfino, M.S. - HIS (03:40):
Every week. Every week, Brad, we would see patients, yeah.
Dr. Brad Stewart (03:44):
You know, our job as audiologists when somebody comes into the clinic isn't to bully them into treatment. Our, our job, if we do it well is to help guide them through that ambivalence and help them come to their own conclusion that treating my hearing loss is something that I do need to do. And so motivational interviewing is really just a kind of a framework and a way to think about asking questions and reflecting and walking alongside a patient as opposed to trying to persuade a patient, so that they can come to their own conclusion that change is necessary.
Blaise M. Delfino, M.S. - HIS (04:15):
Brad, it reminds me a lot...I would always tell the patients really in the beginning of the appointment, not right when I meet them, but, you know, "Brad, I am not here to sell you a hearing aid. I am here to help you make an educated decision regarding your hearing healthcare." And my goodness, does that take that tense energy out of the air. Because yes, treatment option is a hearing aid, but is it really what you need? And conducting that motivational interviewing, thank you so much for, uh, sharing with us the, the ambivalence aspect of working with patients who do present with hearing loss. So, we have just tested the patient's hearing. They present with a mild to a severe high frequency hearing loss with severe speech in noise scores. Okay word discrimination. They have great dexterity, great vision. So a RIC receiver in the canal, hearing aid is the perfect option for them. And they're very busy, which means you're most likely going to recommend premium level technology. When you bring this patient into the technology suite or you have their audiogram presented on a screen in your office, do you have a set presentation? What does this look like? What should the providers be doing? Because now you're not only talking about their hearing loss, you're now going to recommend that they wear hearing aids.
Dr. Brad Stewart (05:43):
Right. Yeah, absolutely. From a high level, I think this entire appointment should be pretty choreographed. I think that a provider should have a very clear picture of how this appointment is structured and kind of the, the questions and the kind of the phases that we're going through. And so after we've tested a patient and we're talking to them about results and recommendations, this is a really critical time to make sure we aren't getting ahead of the patient and to make sure that we're keeping them on the same page as we start talking about these things. So, the first thing that we need to do when we talk about test results is, well, for one thing, and this is, this is what I teach and different people have different opinions here, but I actually don't recommend talking about degrees of hearing loss with patients. Uh, I think most patients don't understand what the audiogram is.
Mm-hmm. <affirmative> in, in many cases I've heard, I've heard of patients hearing mild to severe and the word they locked onto was mild. And then they say, "Well, I have a mild hearing loss, so I must not really need to do anything." Right. So, what I actually recommend is basically saying, if your results are above this level, you have normal hearing, and if your results are below this level, you have a significant hearing loss. Yes. Right? And so, and, and it is surprising how many times I'll tell a patient, and so you do have a significant hearing loss, and I'll just see their face change and they're like, "oh, I have a significant hearing loss." Because as we know, every hearing loss is significant.
Blaise M. Delfino, M.S. - HIS (07:06):
Yes, it is. Even the mild ones, right, Brad, even mild because we know the comorbidities.
Dr. Brad Stewart (07:11):
Yep. So, I think that being clear and being simple as providers is really important so that we don't create opportunities for people to get confused or opportunities for people to think they need to be like kind of making their own decisions when we know you're somebody who should be wearing hearing aids. Right. So, that's the next thing I tell the patient, you have a significant hearing loss. You're somebody who should be wearing hearing aids. Not, "I would recommend hearing aids." Not, uh, "I think we could try a trial with hearing aids." You're somebody who should be, right? So being very clear and then watching their body language. And in some cases they'll kind of close off and they'll clam up and they'll kind of recoil from that. And so it's important if you see that, say, "I noticed when I said that you should be wearing hearing aids that you kind of sat back and crossed your arms and it looks like that wasn't news that you wanted to hear. Tell me, tell me what you're thinking right now." Right? So just being like aware of the human being that's sitting across from you and realizing that we're having a human interaction, and I shouldn't just bulldoze through this presentation. I wanna make sure that they're on the same page with me.
Blaise M. Delfino, M.S. - HIS (08:11):
Absolutely. Brad, I love that. Obviously this is a human interaction. And treating your patient as such and not as a dollar sign is so important. And you had said last month...empathy, you need to be able to see through the eyes of the patient. And this patient may have waited 10 years to pick up the phone to call you, Dr. Brad, to fit them with hearing technology. They know that they probably present with a hearing loss. And for them to muster up that confidence, do something about their hearing loss. Now being told that they have a significant hearing loss, the last thing they want to do is wear hearing aids. But you're positioning yourself, number one as the expert in the field, but now as a friend and a sounding board. And how important is that?
Dr. Brad Stewart (09:02):
Yeah, I, I always try to, when I'm talking to clinics about this, I, our goal is to be the trusted guide. Our goal isn't to be the doctor that prescribes, our goal isn't to be the smartest person in the room. Mm. Our goal is to be the trusted guide. The, the patient is the star here. They're the one that, that every, that the spotlight is on. And we're just facilitating a good environment for that interaction to happen. And I think that's such an important reframe because it takes, it allows you to release expectations of what's gonna happen in this appointment. Yeah. And release any kind of like ulterior motives that you might have that you're hoping you create this result. And instead you're just like taking this person through an experience that's potentially a big inflection point in their life.
Blaise M. Delfino, M.S. - HIS (09:44):
Huge inflection point. It's the beginning of a new journey for them and it's opening up a whole new life for them as well. And I love that the word you used was choreographed. And when your entire team, obviously you've read the E-myth, you have this process, this set process, not only for a clean and check, but when you're working with a brand new patient. The appointment needs to be at least, I mean for us it was 90 minutes, uh, for new patients because we want to build that rapport. And when we talk about this choreographed presentation to get our patients into technology that is going to allow them to what we say, "hear life's story," Have you used or do you recommend using demo devices in this presentation? What does that look like? Because there's different schools of thought here, Brad, in terms of using demo devices during this first appointment.
Dr. Brad Stewart (10:41):
I have strong opinions here.
Blaise M. Delfino, M.S. - HIS (10:43):
I'd Love to hear em
Dr. Brad Stewart (10:44):
Blaise M. Delfino, M.S. - HIS (10:45):
Dr. Brad Stewart (10:47):
I am, I'm extremely pro demonstration. I think that it's really easy for us as audiologists who change people's lives every day to the point where it's, it's interesting. My wife would be like, "You realize that you're like changing people's lives and I've never done that." Like, it's just like such an incredible thing that we get to experience. But we experience it so much that we kind of forget what we're doing. Yes. And we get used to it. Right. We lose sight of how impactful allowing somebody to hear it again is. We, we have the ability while somebody has come to us with this problem, "I can't hear clearly." We have the ability during a 90 minute consultation to change that and to let them experience what hearing is like again. And for a lot of these people, it's been half a decade, a decade, 20 years since they've heard normally. And so that's like such a experience, such a light bulb moment. It's a peak experience. It's something they will remember throughout their life this time when they heard well again. And that we would just like for the sake of efficiency or time just wouldn't do that, and wouldn't allow them to experience such a transformative moment, seems crazy to me. And I have a really hard time rationalizing why you wouldn't do that.
Blaise M. Delfino, M.S. - HIS (12:00):
Brad, we demo in office all the time. I loved it because it's fun. And to see the patient's eyes when you unmute the hearing aids, because I'm sure you did it pretty much the same way in that we would program the hearing aids to their audiogram. I would mute them, put them on, and if they had their wife or their husband or vice versa in with them, I'd always say, "Your voice needs to be the first one that the patient needs to hear." I would say, "Keep it nice. Be nice" <laugh>. Okay. I said, when I, when I hold up, when I give you the thumbs up, I want you to talk to your wife or talk to your husband. And Brad, you know, that's...tears every single time. Mm-hmm. <affirmative>. And to your point, who are we as providers to, to take that away? They've been waiting. They trust us now. We've built the report. To not even demo in the office is crazy to me. For the providers who are saying, "I don't have enough time to demo," we all have 24 hours in the day. And there's some providers who are demoing, there's some that aren't, there's some clinics that are busier than others. Is there a way that the demo process can be streamlined to reduce any type of inefficiency so the providers who are not demoing can start to implement this into their choreographed sales presentation?
Dr. Brad Stewart (13:22):
Yeah. I think that one of the biggest challenges that can happen from demoing, and it's one of the things that I do understand when people are hesitant is, you know, as, as we know hearing aids alone and hearing aids using a manufacturer's first fit settings aren't perfect. Right. And they're not. And it's an estimate, it's a ballpark of what a prescription would be. So, I think one of the best things that we can do is before we put hearing aids in somebody's ears, is just really set the bar pretty low and just say, "Your own voice is gonna sound, sound weird. It's gonna echo, things might sound tinny, it might be too loud. They might not fit in your ears perfectly. They might whistle initially. The good news is when we get your hearing aids and we do a professional fitting, all of those are things that I can address."
Mm-hmm. <affirmative>. So, today I just want you to put it big old, you know, like really take it with a grain of salt because it's, it's just an ex, it's just an example of what better hearing is like. The cool thing when you do that is when you put the hearing aids on, to - today's technology is generally pretty good for most hearing losses. So, for most people you'll put 'em on and they have this really low bar and they'll be like, "oh no, these sound amazing. They sound really good" <laugh>. Yeah. Right. But then on the off chance that it is a rough demo and they do have trouble, you aren't trying to like backpedal and say, oh no, no, no, that's normal. Don't worry about it. You're able to like demonstrate your ability as a clinician to make adjustments on the fly that improve things.
Blaise M. Delfino, M.S. - HIS (14:46):
Dr. Brad Stewart (14:47):
And, and so, and then the other big time suck is just trying to like do a perfect fitting during the demo, which I don't think is what we should be trying to do.
Blaise M. Delfino, M.S. - HIS (14:54):
Absolutely. Because again, the brain - and letting them know your brain is gonna take some time to get used to this. And I would always parallel that to think of it like physical therapy. If you just got shoulder surgery, you're not gonna be <laugh>, you know, going up. And it's gonna take some time for your muscles to get used to that. Think of your brain like a muscle. It's gonna take - whenever we reintroduce sound to the brain, it takes some time to acclimate. Brad, I love the fact that with that choreographed sales presentation, really what you're doing is educating the patient. They are in the driver's seat. You are that trusted guide. I love that, might steal it from you, but I will put you in the footnotes <laugh>. Absolutely. Please do. Please do. Um, what's interesting too, Brad, because we've both fit hundreds of patients and we've changed many lives, which is the coolest thing.
And that is one thing that I'm sure you'll look - I missed that. Um, and I'm looking forward to getting back on the saddle one day of, of working, um, with patients. Cuz I, I just love it. And learning from the generation, the older generation is so cool, you know, they have the best stories. But when you, when you've done this a couple hundred times, you know the questions that are going to be asked, like, "How much do these cost or hearing aids are expensive? Do I really need these?" Would you ever, with your sales presentation, compile all of those frequently asked questions and put those into the sales presentation, so at the end the patient didn't have as many questions? Maybe?
Dr. Brad Stewart (16:29):
Definitely. So, I think one of, you know, one of the biggest requests that I'll get from practices is if I can come in and do training with their team on handling objections. Cause they're getting a lot of objections, right? Mm-hmm. <affirmative>. And so they're having trouble converting people into treatment because they're saying, "Oh, that's too expensive. I need to think about it. I need to talk to my wife." We know those questions are gonna come. Right. So I think it's a lot smarter to be strategic. And so what I've, what I've done is I've identified these seven, I call them power questions, but there's seven questions that if you strategically ask them throughout certain points in the presentation or in the, in the consultation appointment, you're going to elicit conversation and thoughts from the patient that will reveal those objections earlier, like during the discovery process. Mm-hmm. So that you have the opportunity to know where their head's at and potentially even kind of diffuse some of those concerns early on.
Blaise M. Delfino, M.S. - HIS (17:23):
Brad, outta curiosity, understanding the importance of systems, processes, and procedures, my favorite three words, <laugh> really as a, as a private practice owner, how important is it to train your front office staff to ask the right questions during the intake call? And how does that positively influence your sales presentation ability to get that patient into hearing technology?
Dr. Brad Stewart (17:53):
Yeah, totally. I mean, you know, we think about sales, we think about that one appointment, but in reality, the kind of like sales engine, the revenue engine in your practice is from your initial marketing when they first see your name all the way through to five years from now, when they're thinking about upgrading it to new technology mm-hmm. <affirmative>, that entire experience is part of this sales process, right? So it's really all, all the, when I say sales, all I really mean is just this relationship that you have with your patients that causes them to want to keep working with you. The initial intake call, you know, there, so there's one specific thing that can swing your conversion into treatment by about 20%, which is whether or not a companion comes to the appointment mm-hmm. <affirmative>. So, if your front office isn't doing a great job at getting a companion to come with a patient to the appointment, you're gonna see much lower treatment acceptance. I've, I've seen research that shows it's about a 20% lower treatment acceptance rate when there's not a significant other at the appointment. And that's on the front office and that's on your training system to train the front office to do that well.
Blaise M. Delfino, M.S. - HIS (18:55):
Exactly. Bringing a familiar voice because again, if you are demoing in the office, you need that familiar voice because that familiar voice when they now talk to the patient and you're reintroducing sound to the brain, it's going to create that greater acceptance and understanding of, wow, I really do need the hearing technology. Brad, this is a big question here and there could be many answers to this question, but how do you create trust between you and your patients?
Dr. Brad Stewart (19:29):
There's one very tactical thing that I can give you that will probably be the highest impact thing that a cli-clinician could do. Um, and I call this the discovery rule. And so during discovery, I have two rules or two, two things that you're, you're allowed to do during discovery. And discovery is the section of the appointment, typically at the beginning where we're doing kind of case history and understanding the context of why the patient's there and what their goals are. During discovery, my rule is you're only allowed to ask questions or rephrase what the patient just told you. That means no teaching, that means no persuading, it's just curiosity, ask questions, rephrase what they just said for clarity. That's it. And the, and the beautiful thing about that is when you're actively listening like that, that just tells the patient, Hey, they're super dialed into me and what I need. And it just create, because you're not trying to elevate yourself, it just creates a sense that this guy has my best interest at heart.
Blaise M. Delfino, M.S. - HIS (20:26):
I love that.
Dr. Brad Stewart (20:26):
So if you do that one thing, it'll immediately make a huge difference in your consultations.
Blaise M. Delfino, M.S. - HIS (20:32):
Listening twice as much as we speak, rephrasing, continuing to, I love that. And that is absolutely a way in which to create trust and being authentic with it, too. Brad, for our providers tuned in right now, how important is it to continue to sharpen your blade as it relates to sales training? Because we have some school of thought of, "I've been doing this for 15 years, I have my presentation down." I understand that that's wonderful and there's probably a lot of things you're doing that are working well, but the industry is ever evolving. Technology evolves. So, how important is it to continue to sharpen that blade?
Dr. Brad Stewart (21:13):
It's, it's incredibly important. Uh, I think that it's often really almost alarming to providers who've been doing this for a long time and have that mindset that you're describing where it's like, "I've been doing this, I know what I'm doing." If they record a consultation and go back and listen to the entire thing, in most cases they're pretty horrified by what they hear because we have so many things that we habitually do that we don't realize we're doing. And a lot of those can be bad habits that we've just kind of like ingrained into our system. And so, I think that always improving is - it's what's in our pa-patient's best interest, right? To create a better experience, to create a more uniform experience to know if you have multiple providers, it's gonna be the same experience where they, they see me as the owner, or if they see one of my staff providers, it's gonna be consistent. So, you know, whether you're a solo provider or a team, it's just hugely important because that, that consultation process for most audiology practices that treat hearing loss, that's the main driver of patients and revenue in your practice. So, we spend a lot of time learning about hearing aid features. We spend a lot of time learning about, you know, things like cognitive health and tinnitus. But the thing that drives revenue in the practice is are patients coming in seeking help and then moving forward with treatment.
Blaise M. Delfino, M.S. - HIS (22:29):
Brad, if our providers want to connect with you and schedule a one-on-one for sales training, sharpen that blade, where can they connect with you?
Dr. Brad Stewart (22:39):
Great, thanks. Yeah, the best place to go would be my website, which is a AUD.coach. And if you go to that website, then there's a practice assessment that we can go through together where we can kind of identify what the opportunities are in your practice and talk about if there's any opportunity for us to work together. But that website's, aud.coach
Blaise M. Delfino, M.S. - HIS (22:57):
And Brad, I absolutely personally and professionally support everything that you're doing. Again, to our listeners who are providers and interested in sharpening that sales blade, that website is a u d.coach. Again, we had Dr. Brad Stewart, who is an incredible audiologist, amazing human being. And Brad, this has been so fun. We're really looking forward to having you back on the show.
Dr. Brad Stewart (23:21):
Thanks so much.
Blaise M. Delfino, M.S. - HIS (23:22):
You're tuned in to the Hearing Matters podcast, the show that discusses hearing technology best practices, and a growing national epidemic - Hearing Loss. Today, we had Dr. Brad Stewart talk all things sales presentation as it relates to hearing technology. To connect with Brad, visit a u d.coach and until next time, Hear Life's Story.